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CASE STUDY: TEAMWORK CHALLENGES
Ms. Trivaldi is a 53-year-old patient with uncontrolleddiabetes. She is severely underweight and has gastroparesisthat interferes with nutritional absorption and metabo-lism. The bariatric surgeon wanted to put a PICC(peripherally inserted central catheter) line to supplementher nutrition. He referred the patient to a gastroenterolo-gist (GE) for management of the total parenteral nutrition(TPN) solution. However, the GE was concerned withthe management of her diabetes, so she contacted thepatient's endocrinologist for consultation on the amountof insulin that should be added to the TPN mixture. Thebariatric surgeon did not wait for the GE and the endo-crinologist to make their recommendation and placedthe PICC line. He then told the GE to get the TPN solutionprescribed, but she told the bariatric surgeon that shewas not comfortable prescribing the nutritional supple-ment without the endocrinologist recommendation. Whenthe patient asked the bariatric surgeon why she had notbeen started on the supplement, the surgeon told her it was because the GE did not want to prescribe the supple-ment. The patient was very upset with the GE and became dif?cult to work with after talking with the surgeon. Furthermore, once the endocrinologist reviewed the case, he recommended against the TPN because of her uncontrolled diabetes, and the PICC line had to be removed.
Questions
1. Who are the members of the interprofessional health-care team?
2. Can you identify positive and negative examples of interprofessional collaboration? Describe at least one of each.
3. What is the main problem in this case study?4. Which Core Competencies and speci?c Sub-compe-tencies could have improved care in this situation?Identify at least three and explain your rationale.
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